1     
DENTAL PRACTICE ACT AMENDMENTS

2     
2020 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Allen M. Christensen

5     
House Sponsor: ____________

6     

7     LONG TITLE
8     General Description:
9          This bill addresses the use of teledentistry to provide dental care.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms;
13          ▸     provides for the use of teledentistry within the state by dentists licensed within the
14     state;
15          ▸     provides that the standard of dental care for teledentistry is the same for in-person
16     dental care;
17          ▸     establishes the dental services a dentist may and may not provide using
18     teledentistry;
19          ▸     directs the Division of Occupational and Professional Licensing to make rules
20     regarding teledentistry; and
21          ▸     makes technical and conforming changes.
22     Money Appropriated in this Bill:
23          None
24     Other Special Clauses:
25          None
26     Utah Code Sections Affected:
27     AMENDS:
28          58-69-102, as last amended by Laws of Utah 2015, Chapter 343
29          58-69-301, as last amended by Laws of Utah 2015, Chapter 320
30          58-69-801, as last amended by Laws of Utah 2016, Chapter 348
31          58-69-802, as enacted by Laws of Utah 1996, Chapter 116
32     ENACTS:
33          58-69-807, Utah Code Annotated 1953
34     

35     Be it enacted by the Legislature of the state of Utah:
36          Section 1. Section 58-69-102 is amended to read:
37          58-69-102. Definitions.
38          In addition to the definitions in Section 58-1-102, as used in this chapter:
39          (1) "Asynchronous technology" means store-and-forward technology that allows a
40     dentist or a dental hygienist to transmit a patient's health information to a dentist for viewing at
41     a later time.
42          [(1)] (2) "Board" means the Dentist and Dental Hygienist Licensing Board created in
43     Section 58-69-201.
44          [(2)] (3) "Dental assistant" means an unlicensed individual who engages in, directly or
45     indirectly, supervised acts and duties as defined by division rule made in collaboration with the
46     board.
47          [(3)] (4) "Direct supervision" means the supervising dentist is present and available for
48     face-to-face communication with the person being supervised when and where professional
49     services are being provided.
50          [(4)] (5) "General supervision" means that the supervising dentist is available for
51     consultation regarding work the supervising dentist has authorized, without regard as to
52     whether the supervising dentist is located on the same premises as the person being supervised.
53          [(5)] (6) "Indirect supervision" means that the supervising dentist is present within the
54     facility in which the person being supervised is providing services and is available to provide
55     immediate face-to-face communication with the person being supervised.
56          [(6)] (7) "Practice of dental hygiene" means, regarding humans:
57          (a) under the general supervision of a dentist, or under a written agreement with a
58     dentist licensed under this chapter, as provided in Section 58-69-801, to:
59          (i) perform preliminary clinical examination of human teeth and gums;
60          (ii) make preliminary instrumental examination of patients' teeth;
61          (iii) expose dental radiographs;
62          (iv) assess dental hygiene status and collaborate with the supervising dentist regarding
63     a dental hygiene treatment plan for a patient;
64          (v) remove deposits, accumulations, calculus, and concretions from the surfaces of
65     human teeth;
66          (vi) remove toxins and debris from subgingival surfaces;
67          (vii) provide dental hygiene care in accordance with a dentist's treatment plan for a
68     patient;
69          (viii) take impressions of teeth or jaws except for impressions or registrations to supply
70     artificial teeth as substitutes for natural teeth; or
71          (ix) engage in other practices of dental hygiene as defined by division rule;
72          (b) under the indirect supervision of a dentist to administer in accordance with
73     standards and ethics of the professions of dentistry and dental hygiene:
74          (i) local anesthesia; or
75          (ii) nitrous oxide analgesia;
76          (c) to represent oneself by any title, degree, or in any other way as being a dental
77     hygienist; or
78          (d) to direct a dental assistant when the supervising dentist is not on the premises.
79          [(7)] (8) "Practice of dentistry" means the following, regarding humans:
80          (a) to offer, undertake, or represent that a person will undertake by any means or
81     method, including teledentistry, to:
82          (i) examine, evaluate, diagnose, treat, operate, or prescribe therapy for any disease,
83     pain, injury, deficiency, deformity, or any other condition of the human teeth, alveolar process,
84     gums, jaws, or adjacent hard and soft tissues and structures in the maxillofacial region;
85          (ii) take an appropriate history and physical consistent with the level of professional
86     service to be provided and the available resources in the facility in which the service is to be
87     provided;
88          (iii) take impressions or registrations;
89          (iv) supply artificial teeth as substitutes for natural teeth;
90          (v) remove deposits, accumulations, calculus, and concretions from the surfaces of
91     teeth; and
92          (vi) correct or attempt to correct malposition of teeth;
93          (b) to administer anesthetics necessary or proper in the practice of dentistry only as
94     allowed by an anesthesia permit obtained from the division;
95          (c) to administer and prescribe drugs related to and appropriate in the practice of
96     dentistry;
97          (d) to supervise the practice of a dental hygienist or dental assistant as established by
98     division rule made in collaboration with the board; or
99          (e) to represent oneself by any title, degree, or in any other way that one is a dentist.
100          [(8)] (9) "Public health setting" means:
101          (a) an individual's residence, if the individual is unable to leave the residence;
102          (b) a school, as part of a school-based program;
103          (c) a nursing home;
104          (d) an assisted living or long-term care facility;
105          (e) a community health center;
106          (f) a federally-qualified health center; or
107          (g) a mobile dental health program that employs a dentist who is licensed under this
108     chapter.
109          [(9)] (10) "Supervising dentist" means a licensed dentist who has agreed to provide
110     supervision of a dental hygienist or unlicensed individual in accordance with the provisions of
111     this chapter.
112          (11) "Synchronous technology" means two-way audiovisual technology that allows a
113     dentist to see and communicate in real time with a patient who is located in a different physical
114     location.
115          (12) "Teledentistry" means the practice of dentistry using synchronous or asynchronous
116     technology.
117          [(10)] (13) "Unlawful conduct" means the same as that term is defined in Sections
118     58-1-501 and 58-69-501.
119          [(11)] (14) "Unprofessional conduct" means the same as that term is defined in
120     Sections 58-1-501 and 58-69-502 and as may be further defined by rule.
121          Section 2. Section 58-69-301 is amended to read:
122          58-69-301. License required -- License classifications -- Anesthesia and analgesia
123     permits.
124          (1) A license is required to engage in the practice of dentistry, including teledentistry,
125     or dental hygiene except as specifically provided in Section 58-69-306 or 58-1-307.
126          (2) The division shall issue to individuals qualified under the provisions of this chapter
127     a license in the classification:
128          (a) dentist; or
129          (b) dental hygienist.
130          (3) A permit is required to engage in administration of anesthesia or analgesia in the
131     practice of dentistry or dental hygiene.
132          (4) The division in collaboration with the board shall establish by rule:
133          (a) the classifications of anesthesia and analgesia permits and the scope of practice
134     permitted under each permit; and
135          (b) the qualifications for each classification of anesthesia and analgesia permit.
136          Section 3. Section 58-69-801 is amended to read:
137          58-69-801. Dental hygienist -- Limitations on practice.
138          (1) A dental hygienist licensed under this chapter may only practice dental hygiene:
139          [(1)] (a) in an accredited dental or dental hygienist school to teach and demonstrate the
140     practice of dental hygiene;
141          [(2)] (b) for a public health agency;
142          [(3)] (c) under the supervision of a dentist, for an employee leasing company or
143     temporary personnel service company providing employees to a dentist or other person
144     lawfully providing dental services:
145          [(a)] (i) under the indirect supervision of a dentist licensed under this chapter at any
146     time the dental hygienist is administering an anesthetic or analgesia as permitted under this
147     chapter or division rules made under this chapter;
148          [(b)] (ii) under the general supervision of a dentist licensed under this chapter within
149     the office of the supervising dentist and upon patients of record of the supervising dentist; and
150          [(c)] (iii) under the general supervision of a dentist licensed under this chapter, and the
151     practice is conducted outside of the office of the supervising dentist, if:
152          [(i)] (A) the dental hygiene work performed is authorized by the supervising dentist as
153     a part of and in accordance with the supervising dentist's current treatment plan for the patient;
154          [(ii)] (B) no anesthetic or analgesia is used;
155          [(iii)] (C) the supervising dentist has determined the patient's general health and oral
156     health are so that the dental hygiene work can be performed under general supervision and with
157     an acceptable level of risk or injury as determined by the supervising dentist;
158          [(iv)] (D) the supervising dentist accepts responsibility for the dental hygiene work
159     performed under general supervision; and
160          [(v) (A)] (E) the dental hygienist's work is performed on a patient who is homebound
161     or within a hospital, nursing home, or public health agency or institution[; and (B)], the patient
162     is the supervising dentist's patient of record, and the dentist has examined the patient within six
163     months prior to the patient's receiving treatment from a dental hygienist under this Subsection
164     [(3)] (1)(c); or
165          [(4)] (d) under a written agreement with a dentist who is licensed under this chapter
166     and who is a Utah resident if:
167          [(a)] (i) the dental hygienist practices in a public health setting;
168          [(b)] (ii) the dentist is available in person, by phone, or by electronic communication;
169          [(c)] (iii) the agreement provides that the dental hygienist shall refer a patient with a
170     dental need beyond the dental hygienist's scope of practice to a licensed dentist; and
171          [(d)] (iv) the dental hygienist obtains from each patient an informed consent form that
172     provides that treatment by a dental hygienist is not a substitute for a dental examination by a
173     dentist.
174          (2) A dentist's use of teledentistry is not an expansion of the scope of practice for
175     dental hygienists.
176          Section 4. Section 58-69-802 is amended to read:
177          58-69-802. Practice within limits of law, education, training, experience, and
178     competency -- Standard of care.
179          (1) Each individual licensed under this chapter shall confine his practice to those acts
180     or practices:
181          [(1)] (a) permitted by law; and
182          [(2)] (b) in which the individual is competent by education, training, and experience.
183          (2) (a) The standard of dental care a dentist provides through teledentistry is the same
184     as the standard of dental care a dentist provides in a traditional physical setting.
185          (b) A dentist who provides dental care through teledentistry shall use evidence-based
186     teledentistry standards of practice and practice guidelines, to the degree available, to ensure
187     patient safety, quality of care, and positive outcomes.
188          (c) A dentist may:
189          (i) use teledentistry to conduct an examination for a new patient or for a new diagnosis
190     if the examination is conducted in accordance with evidence-based standards of practice to
191     sufficiently establish an informed diagnosis; and
192          (ii) after conducting an examination in accordance with Subsection (2)(c)(i), delegate
193     the needed dental services.
194          (d) A dentist may not conduct a dental examination using teledentistry if the standard
195     of care necessitates a traditional physical dental examination.
196          Section 5. Section 58-69-807 is enacted to read:
197          58-69-807. Use of teledentistry -- Informed consent -- Rulemaking.
198          (1) A dentist may provide the following dental services using teledentistry:
199          (a) supervising a dental hygienist in the completion of the following at a public health
200     setting, generally with a written collaborative agreement, directly, or indirectly, in accordance
201     with this chapter:
202          (i) gathering diagnostic information to be used by the dentist at a remote location to
203     form a tentative basic treatment plan and provide appropriate preventive or urgent
204     prescriptions;
205          (ii) perform preventive dental procedures;
206          (iii) provide oral health education; and
207          (iv) perform any palliative or interim treatment or caries arresting treatment outlined in
208     the dentist's treatment plan and authorized by the dentist, in accordance with this chapter and
209     rules made in accordance with this chapter; and
210          (b) at a remote location, using records and diagnostic information that a dental
211     hygienist provides to form a tentative treatment plan for basic dental procedures.
212          (2) A dentist may not, using teledentistry at a remote location, form an advanced final
213     treatment plan, including any of the following:
214          (a) an endodontic treatment plan;
215          (b) a fixed or removable prosthodontics treatment plan;
216          (c) a surgical treatment plan; or
217          (d) an orthodontic treatment plan.
218          (3) A dentist or any entity employing a dentist may not require a patient to sign an
219     agreement that limits the patient's ability to file a complaint with the division.
220          (4) When a dentist uses teledentistry, the dentist shall ensure informed consent covers
221     the following additional information:
222          (a) a description of the types of dental care services provided through teledentistry,
223     including limitations on services;
224          (b) the name, contact information, licensure, credentials, and qualifications of all
225     dentists and dental hygienists involved in the patient's dental care; and
226          (c) precautions and protocols for technological failures or emergency situations.
227          (5) The division shall make rules, in accordance with Title 63G, Chapter 3, Utah
228     Administrative Rulemaking Act, to establish requirements and parameters regarding
229     teledentistry to ensure the safe use of teledentistry, including additional provisions for:
230          (a) transparency, disclosure, and informed consent;
231          (b) standard of care;
232          (c) proper documentation;
233          (d) supervision and scope of practice;
234          (e) patient complaints; and
235          (f) protocols for referrals.